1 Diagnosing dementia
If you suspect that you or a relative has dementia, it is important for them to get a timely professional diagnosis so that they can get the support they need. Below outlines the five steps to diagnosing dementia.
1. Talk it through
As a first step, it can be a good idea to sit down and discuss the problem with your relative if this is something you're comfortable doing. Choose a time when you can sit down together, without any interruptions, to talk things through. Your relative may have noticed that there have been problems. However, people with dementia may not recognise or wish to acknowledge that they have any symptoms and may not be aware of their memory loss, which can make it more difficult to bring up the subject.
When you chat, you can try to gauge their awareness of the problem and the extent of the difficulties he or she is experiencing, giving some examples. You can also explain that some memory changes in later life are normal and that there can be many explanations.
2. Visit a GP
If you or your relative are unhappy with the GP’s decision, you can talk if through with the GP. If you’re still unhappy with their response, you can seek a second opinion from another GP.
Your relative’s GP should be the first port of call if you or your relative have concerns about memory problems or any of the symptoms mentioned in What is dementia?. It can be helpful if a family member can accompany the person who has a memory problem if possible, because he or she is likely to need support and reassurance. The GP might also ask you to provide information about the difficulties you think your relative has been experiencing and you can find out what tests or referrals are being proposed or organised.
The GP should ask questions to rule out other causes of memory loss (for example, head injury, stress, medication with side effects, possible infections or any thyroid or vitamin deficiencies). They might also carry out a physical examination and tests to assess mental ability. If they suspect that the problems might be caused by a progressive condition such as dementia, they may want to review your relative in a few weeks’ or months’ time, or refer them to a specialist for an assessment.
3. Referral to a specialist
Depending on your relative’s age and other medical conditions or symptoms, the GP will probably refer to a specialist – such as a neurologist, an old-age psychiatrist or the local memory assessment service – for a more thorough assessment. A specialist service will have more knowledge and experience about the condition, as well as have access to specialist testing (such as brain scans) and support services.
If you want a referral but the GP doesn't offer it, discuss it with the doctor - they may have a good reason not to refer. If after talking to the GP you still feel that you want a referral, you may wish to get a second opinion from another doctor.
4. The assessment
An assessment might be carried out by a consultant-led team in a hospital or a mental health team visiting your relative at home. It is likely to involve taking a detailed medical history, physical examination, mental tests and scans. The specialist team will provide information and support about diagnosis and potential drug therapies, which may improve symptoms depending on the type of disease.
Part of the diagnosis is made by excluding other conditions, so it is important for the consultant to get the full picture. Carers, relatives and friends can help to provide this detailed background information. It might be helpful to keep a diary of what’s been happening or think about examples when you have noticed memory loss, and bring some notes to the meeting with the specialist.
These may consist of pen and paper-type tests, and questions focusing on memory as well as verbal and non-verbal abilities. These tests can help to determine the type of problem a person has, particularly in the early stages. The assessment can also be used as a benchmark to measure any changes over time.
The professional carrying out the assessment may refer your relative for a brain scan.
The scan can help with getting a dementia diagnosis but also discover if factors such as strokes or a brain tumour could be behind your relative’s memory problems.
The vast majorities of scans that do show changes in the brain will not be because of a serious problem that will affect your relative’s life span or quality of life. Instead, they are what are known as ‘false positives’, and it’s important to bear in mind that this is common before your relative goes in for the scan.
The specialist team carrying out the assessment should send the results to your relative’s GP. They will also communicate with you about the diagnosis. In most cases, the GP or consultant will make an appointment with your relative to discuss the results, and what they mean. They may also ask a close family member to be present.
The consultant will help the person with dementia and their family to understand the impact of the diagnosis, and the team of professionals working with them will also be able to offer advice.